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Hemoglobin Levels are Low in Sarcopenic and Osteosarcopenic Older Persons

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Abstract

Anemia is commonly associated with osteoporosis and sarcopenia in older persons. However, there is a common subset of patients identified as osteosarcopenic at a higher risk of adverse outcomes. Whether these patients are also at a higher risk of anemia remains unknown. In this study, we aimed to compare hemoglobin (Hb) levels in osteosarcopenic older subjects versus those with sarcopenia, osteopenia/osteoporosis alone and controls. Cross-sectional study in 558 community-dwelling participants older than 65 (mean age 79 ± 7.5 years) from Western Sydney, Australia. Associations of anemia with sarcopenia, osteopenia/osteoporosis and osteosarcopenia were assessed. Participants were able to mobilize independently, reported a risk/history of falls and were not cognitively impaired. We used the original (EWGOP) and revised (EWGSOP2) European consensus on definition of sarcopenia, and WHO definitions of osteoporosis and osteopenia. Based on both European definitions of sarcopenia prevalence of anemia was the highest among sarcopenic patients (39%), followed by osteosarcopenic (34%), osteoporotic/penic (26%), and controls (24%). Anemia prevalence in total was 176/553 (31.5%). Osteosarcopenic patients on average had 6.3 g/L lower Hb levels compared to controls (p = 0.001), and 3.7 g/L lower Hb than patients with osteoporosis/penia (p < 0.026). Interestingly, levels of Hb did not differ between sarcopenic vs osteosarcopenic patients (p = 0.817) and between osteoporotic/osteopenic patients vs controls (p > 0.259). The higher prevalence of anemia and lower hemoglobin in sarcopenic and osteosarcopenic subjects compared to osteoporotic/penic participants and controls was established. However, the previously reported associations between osteoporosis and anemia were not confirmed. A likely explanation can be inclusion of osteosarcopenic subjects as osteoporotic in previous studies.

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Acknowledgements

This study was supported by the Australian Institute for Musculoskeletal Science (AIMSS) and the Aged Care Division at Nepean Hospital – Penrith (Australia). Ebrahim Bani Hassan received a Medical Research Future Fund (MRFF) fellowship under Rapid Applied Research Translation (RART) program in conjunction with the Melbourne Academic Centre for Health (MACH). The authors are grateful to Ms Paula Casas for the review of the paper.

Funding

The study was funded by the Australian Institute for Musculoskeletal Science (AIMSS).

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Author notes

  1. Ebrahim Bani Hassan and Sara Vogrin have Contributed equally to this work

Authors and Affiliations

  1. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Sunshine Hospital, L3 WCHRE Bldg, 176 Furlong Road, St Albans, VIC, 3021, Australia

    Ebrahim Bani Hassan, Sara Vogrin & Gustavo Duque

  2. Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia

    Ebrahim Bani Hassan, Sara Vogrin & Gustavo Duque

  3. Javea Health Centre, Denia Hospital, Alicante, Spain

    Idaira Hernandez Viña

  4. Falls and Fractures Clinic, Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia

    Derek Boersma & Pushpa Suriyaarachchi

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  1. Ebrahim Bani Hassan
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Contributions

GD and EB were involved in the conception of the study, developing the research questions and hypothesis and interpretation of the results. GD, PS and DB performed the assessments and were involved in data collection. The manuscript was drafted by EB with the help of SV and IHV under GD’s supervision. Statistical analyses were conducted by SV and EB. All authors agree and accept responsibility for the contents of the manuscript.

Corresponding authors

Correspondence to Ebrahim Bani Hassan or Gustavo Duque.

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Conflict of interest

Ebrahim Bani Hassan, Sara Vogrin, Idaira Hernandez Viña, Derek Boersma, Pushpa Suriyaarachchi, and Gustavo Duque declare that they have no conflict of interest.

Ethical Approval

All participants in this study have given their written informed consent for being referred to the Falls and Fractures Clinic and the consequent use of their anonymous data for research. The study protocol has been approved by the research institute’s committee on human research (approval HREC/12/NEPEAN/150).

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Bani Hassan, E., Vogrin, S., Hernandez Viña, I. et al. Hemoglobin Levels are Low in Sarcopenic and Osteosarcopenic Older Persons. Calcif Tissue Int 107, 135–142 (2020). https://doi.org/10.1007/s00223-020-00706-2

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